The Medical Council of India (MCI) plans to conduct a nationwide entrance examination for admission to the MBBS course. The MCI reasons its action by stating that it wants to improve the level of Medical Education in India.
There can be no second opinion that the level of medical education in India is far from satisfactory. There is an urgent need to reassess the standards, content and methodology of medical education in India.
The selection of the best students for training may be a prerequisite for meeting the standards. But it is still a small step to achieve quality training. Unfortunately, for any other professional education in India, the selection process for admission appears as the sole determinant of quality. The infrastructure of the institution, the quality of the teachers, the availability of clinical material, the methodology, the research potential and the uniformity of the standards throughout the country do not attract attention and debate. This is unfortunate considering the vast difference in educational standards in various parts of our country and between institutions within states.
Our medical education needs to be evaluated with regard to its content and relevance. MBBS course is called as “Medical Education” in India while all over the world it is called as Medical Training. There is a sea of difference between the word ‘education’ and ‘training’. Indian medical education involves studying volumes and volumes of books and gaining theoretical knowledge with much less practical training. Like any other education in India, medical education does not help the student to develop practice-oriented clinical management and thinking methodologies. Students trained in the UK or US are better equipped to deal with a patient in a clinic or ER, even if they haven’t read as many books as their Indian counterparts.
UK textbooks are intended for UK medical trainees. Situations are presented as if it were a UK hospital. American medical books feature the American hospital environment and American patients. For example, trauma care management is presented in American textbooks with the setting of the American ambulance service and emergency room in mind. That is not the situation in our country. Western textbooks give more importance to metabolic diseases and congenital diseases that constitute a significant burden of disease in their countries. Our students read British and American medical textbooks. This may be one of the reasons why everyone wants to go to Great Britain and the United States!
They are not trained to go to an indigenous town and see a patient in a Primary Health Center. They don’t read much about malaria and skin infections that are so common in our country. They do not have books that give them comprehensive knowledge about the Indian clinical scenario nor do they receive adequate training for Indian clinical practice. We need more research on Indian epidemiology and teaching materials based on that.
We hear people talk about training our graduates to ‘international standards’. They insist that our professionals should be able to go to any country in the world and survive. The percentage of Indian medical graduates going abroad will be less than one percent. Should we design our medical curriculum to help these less than 1% achieve their personal goals? No country in the world should plan its educational programs to prepare its students to go abroad. We need doctors to serve our citizens. We want a large number of doctors to work in rural India. It is crazy to talk about ‘international standards’ when what we need is a true ‘Indian standard’.
Another big disadvantage for the Indian student is that he has to learn medicine in a foreign language. The best way to learn science or medicine is to learn in the mother tongue. That will make the learning process interesting and help develop investigative thinking. Every European, whether German, Spanish, French or Russian, studies medicine in their mother tongue. China, Japan, and even a small country like Thailand provide medical education in their mother tongue. It’s a posibility. it is practical. The only opposition would be that our students cannot go abroad and work. That is a lame excuse. First of all, that medical graduates do not go abroad, leaving our country. If they want to go to another country that speaks a different language for training, they have to do exactly what the Chinese, the Japanese, and the Russians are doing. Graduates from these countries if they want to go abroad have to learn English, German or French or any language through a short course. Our students should do that too. Our students can study English as a second language at school. We can even add English language teaching into the Medicine curriculum as an option. So there can be no excuses for not teaching Medicine in their respective mother tongues in all states.
When so much needs to be done to improve the standard of medical education in India, projecting a common entrance examination to enter medical education as the panacea for all these problems will be counterproductive.
The selection of candidates for the MBBS course is an important step to improve the level of education. The selection process needs to be regularized. Private medical institutions and so-called ‘presumptive universities’ have freedom of choice. A student who has failed the matriculation exam and passed on the second attempt may also purchase a seat at these institutions. Most of the students who enter some of these institutions have obtained more than ten points less than the lowest grade of a student who enters the government institution in the reserved category. There is no minimum qualification barrier to enter many of the private institutions. There is no competitive test for admission. The only criteria is money. The seats are sold by open auction. This is of great concern when it comes to maintaining the level of medical education. We need to regularize the selection process, the admission modalities and the fee structure of private institutions to achieve the standards. MCI appears to be unconcerned with these issues for unknown reasons.
The Tamil Nadu experience has clearly shown the detriment of entrance examinations. The abolition of the entrance exam has increased the percentage of rural students entering professional courses from 28% to 64%. The reintroduction of the entrance exam will reverse this and hurt rural students. School education is already big business. The abolition of the entrance examination helped not only rural students but also students from government secondary schools to enter professional colleges. If CET is introduced, private schools that offer entrance exam training along with the regular curriculum will be happy to improve their business. Entrance examination training centers will flourish in cities, and wealthy, urban students will gain undue advantages. Rural students will be marginalized.
The reason why IITs, National Law Schools and central government medical institutions remain the haunt of students from metropolitan cities is that the entrance examination to all these institutions is based on the CBSE syllabus. Again, looking at the Tamil Nadu experience, it can be seen that out of the six and a quarter lakh students studying the twelfth standard, about five lakh are state curriculum students, about one and a half lakh are registration. Only six thousand or so students study the CBSE curriculum. Obviously, the CET will be based on the CBSE syllabus, which is more voluminous than other syllabuses. This will benefit a microscopic minority and exclude large numbers of poor and dispossessed from the rural sector.
The entrance exam is perceived as bad in Tamil Nadu. Dr. Ramadoss, who waged a relentless war against the entrance exam for more than a decade, finally convinced the state government to abolish the entrance exam. This was a big step in empowering rural students. The reintroduction of the entrance exam will destroy these benefits for rural students. MCI should drop its CET efforts and work to improve the standard of medical training.